MEDICARE: ALA ABDELRAHIM D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.035055	IL

General Provider Information

NPI Number	:	1952140147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALA ABDELRAHIM D.M.D.

Provider Business Mailing Address
First Line	:	16670 LIBERTY CIR UNIT 2S
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-5715
Country	:	US
Telephone Number	:	708-802-3426
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 E 93RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3607
Country	:	US
Telephone Number	:	773-530-7550
Fax Number	:	773-530-0287

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	05/20/2024

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